Cardiac Flashcards
1
Q
optimal way to obtain hemodynamics/ for vessels
A
angio
2
Q
causes of AS
A
65: degeneration and sclerosis of valve
3
Q
lab findings of AS
A
ECG: LVH, Increased QRS or just R amplitute
CXR: LVH, Ca deposit
Echo: immobile valves LVH
4
Q
Findings of AS
A
- hyperdynamic LV
- soft/normal S1
- absent A2
- paradoxical splitting of the S2
- Ejection click
- prominent S4
- systolic murmur
5
Q
st segment depression
A
myocardial hypoxia
6
Q
indications for intervention of AS
A
sx: angina, syncope, dyspenia, chf
EF<50%
CAD with moderate AS
sever/critical AS
7
Q
HCM
A
hypertrophic cardiomyopathy :subvalvular as
8
Q
HCM
A
no calcification of av, murmur louder standing or valsalvaing , ejection sound uncommon, similiar sx to AS
9
Q
tx of HCM
A
ca chan blocker, beta blocker
10
Q
acute AR etiologies
A
aortic dissection, iatrogenic-cath/surgical, endocarditis
11
Q
chronic AR etiologies
A
- rheumatic valve dz (~30%), bicuspid aortic valve, dilated aortic root, bacterial endocarditis, senile degeneration, connective tissue dz
12
Q
RA, Marfans, ehlers-danlos may cause
A
AR
13
Q
narrow PP
A
AS
14
Q
wide PP (low diastolic)
A
AR
15
Q
chronic AR results in
A
LV overload, dilation, hypertrophy, HF
16
Q
acute AR results in
A
pulmonary edema
17
Q
PE findings of AR
A
high pitched diastolic decescendo murmur at aortic are and left sternal border
18
Q
austin flint murmur
A
low pitch diastolic murmur at the apex sounds like a diastolic mitral stenosis murmur
19
Q
wide PP
A
increased systolic and decreased diastolic –>water hammer or corrigan pulse
20
Q
Acute MR
A
papillary m. necrosis and rupture, endocarditis
21
Q
marfans, graves dz, muscular dyst. a/w
A
barlows syndrome –>MR
22
Q
Acute MR
A
papillary m. necrosis and rupture, endocarditis
23
Q
marfans, graves dz, muscular dyst. a/w
A
barlows syndrome –>MR
24
Q
MR RV failure signs
A
JVD, Hepatomegaly, edema
25
MR pulmonary HTN
s4 gallops, loud p2, rv heave and lift
26
most common cause of MS
rheumatic heart dz
27
emboli to the brain a/w
MS
28
most common cause of MS
rheumatic heart dz
29
anticoagulant
bleeding and thromboembolism
30
most common cause of hf
CAD
31
used to differentiate pulmonary from cardiac dz in pt w dyspnea and/or an inconclusive PE
BNP level
32
most common cause of hf
CAD
33
used to differentiate pulmonary from cardiac dz in pt w dyspnea and/or an inconclusive PE
BNP level
34
recommended initial therapy for ALL pt with HF
ACE inh., digoxin, diuretics
35
diastolic dysfunction is more common in
elderly female with HTN and DM
36
side effect of ACE
cough and renal dysfunction (okay)
37
ARBs (angiotensin-receptor blockers)
use if ACE not tolerated , assess bp, renal fxn, electrolytes regularly
38
digoxin
pt w a fib
39
indication of sporonolactone
pt with rest dyspnea within past 6 months, post MI with systolic dysfxn
40
digoxin
pt w a fib
41
PE sx
dyspnea, productive cough, diaphoresis
42
management of PE
O2, morphine, diuretics, nitrates
43
most common cause of HF is
left ventricular systolic dysfxn
44
side effect of statins
myopathy (check CK level), elevated LFTs
45
most common cause of HF is
left ventricular systolic dysfxn
46
bile acid sequesterant contraindication
pt with hyperTAG
47
side effect of nicotinic acid (niacin)
flushing due to increased prodtoglandin D2 production
48
initial dx study for chest pain
ecg
49
cardiac enzymes
CK, CKMB, Troponins
50
initial dx study for chest pain
ecg
51
cardiac enzymes
CK, CKMB, Troponins
52
stress test drugs
adenosine, dipyridamole, dobutamine, isopproterenol
53
absolute contraindication of exercise stress test
acute MI/ACS, acute myo/pericarditis, rapid a/v arrhythmias, sever AS, anemia, acute illness, infection, hyperthyroidism, acute aortic dissection
54
in ex ekg looking for
st depression, increased hr, chest pain, sob, lightheadedness
55
absolute contraindication of exercise stress test
acute MI/ACS, acute myo/pericarditis, rapid a/v arrhythmias, sever AS, anemia, acute illness, infection, hyperthyroidism, acute aortic dissection
56
NMI
a perfusion defect is seen in areas of hypoperfusion
57
indications of NMI
assess areas of ischemia, location and size of muscle after MI, dx narrowing of arteries, evaluate how grafted vessels work after CABG, evaluate effectiveness of balloon
58
TEE can detect
clots, septal defect, PFO, ascending aortic atherosclerosis, aortic dissection, valvular pathologies, vegetation, better myocardial motion
59
TTE for blood flow
color flow doppler technique
60
TEE can detect
clots, septal defect, PFO, ascending aortic atherosclorosis, aortic dissection, valvular pathologies, vegetation, better myocardial motion
61
cath/angio risk
bleeding, arrhythmias, vessel injury, post op bleeding, emboli, renal failure
62
indications for cath/angio
known/suspected cad: unstable angina, angina, hx of MI, inadequate response to tx, post resuscitation from cardiac arrest,
atypical chest pain with high risk of cad, abnl LV fxn/LV failure
before valve surgery in pt with chest pain
63
cath/angio risk
bleeding, arrhythmias, vessel injury, post op bleeding
64
indications for cath/angio
known/suspected cad: unstable angina, angina, hx of MI, inadequate response to tx, post resuscitation from cardiac arrest,
atypical chest pain with high risk of cad, abnl LV fxn/LV failure
before valve surgery in pt with chest pain
65
indication of holter
eval of syncope, palpitations, rhythm recording not good for infrequent , hr variability, st seg monitoring, detects silent ischemia
66
implantable loop recorder useful in..
infrequent sx, suspected arrhythmia but invasive testing has been inconclusive
67
risk factors for IHD
cocaine, DM1, hypercholestrolemia, FH
68
atypical symptoms of myocardial ischemia
dyspnea, fatigue, nausea, faintness : most common in elderly and DM pts
69
indication of holter
eval of syncope, palpitations, rhythm recording not good for infrequent , hr variability, st seg monitoring, detects silent ischemia
70
implantable loop recorder useful in..
infrequent sx, suspected arrhythmia but invasive testing has been inconclusive
71
CT indications
aortic disscection, coronary artery Ca deposition, atherosclerosis
72
MRI indications
lengthy not good for ER
73
risk factors for IHD
cocaine, DM1, hypercholestrolemia, FH
74
atypical symptoms of myocardial ischemia
dyspnea, fatigue, nausea, faintness : most common in elderly and DM pts
75
first line med for chronic angina
beta blockers
76
beta blockers
decrease HR, BP, Contractility
77
nitrates
reduce preload
78
ca channel blockers
decrease BP, contractility, and act as coronary vasodilator
79
ca channel blocker is indicate for pt who
dont respond to nitrates and beta blockers
80
med increasing oxygen supply
nitrates and ca channel blockers
81
anti platelet meds
aspirin and plavix or combination of both
82
revascularization
PCI and CABG
83
Tx of stable angina
1. med to decrease oxygen demand
2. med to increase oxygen supply
3. anti platelet meds
4. revascularization
84
PCI
hx of angina despite medical tx, evidence of ischemia on stress testing, with or without stent placement
85
CABG
left main coronary stenosis
| triple vessel dz, use saphenous vein or internal mammary arteries
86
atypical presentation of ACS in
elderly and DM
87
atypical presentation of ACS
sudden breathlessness
88
most common cause of ua/nstemi
plaque rupture or erosion with a superimposed nonocclusive thrombus
89
dynamic obstruction
coronary a. spasm
90
coronary a. spasm what angina
prinztmetal's angina
91
unstable angina
ischemic discomfort with at least one sx: occurs at rest lasting >10 min, sever and of new onset, with crescendo pattern
92
troponin stays in blood up to
2 weeks
93
ck-mb stays in blood up to
2 days
94
unstable angina lab findings
no elevation of CK-MB or troponin-no myocardial necrosis
| maybe ST depression or T wave inversion
95
NSTEMI lab findings
definite elevation of CK-MB and/or troponin -actual infarct
no ST elevation
maybe ST depression or T wave inversion
96
Tx of UA/NSTEMI
bed rest with cardiac monitoring and O2, nitrates, beta blockers, calcium channel blockers (if sx not relieved by beta blockers and nitrates), morphine (if symptoms not relieved by nitrates, anti thrombotic rx (aspirin, clopidogrel), anti coagulation with heparin, revascularization
97
increased risk of STEMI in pt with
multiple risk factor and/or history of UA
98
pathophysiology of STEMI
rupture of a vulnerable plaque in the setting of atherosclerotic coronary artery dz=> complete occlusion of coronary a. MOST COMMON ETIOLOGY
99
precipitating factors for STEMI
vigorous exercise, emotional stress, medical/surgical illness/ within a few hrs of awakening in the morning
100
Dx approach to suspected ACS
12 lead ECG, cardiac markers, cardiac imaging (2D echo to assess wall motion abnl), angio,CBC, lipids, CXR
101
ST elevation with + enzymes
STEMI
102
No ST elevation with + enzymes
NSTEMI
103
-enzymes
UA
104
ACS management
MONA= oxygen, nitroglycerin and morphine for pain, aspirin (antiplatelet therapy to limit size of infarct)
105
Tx of STEMI
MONA, beta blockers-metoprolol, calcium channel blockers if sx are relieved by beta blockers and nitrates, morphine if sx not relieved by nitrate, anti thrombotic, anticoagulation w/heparin, anti arrhythmias, ace inhibitors, statins, REPERFUSION
106
perfusion therapy
for STEMI, to limit size of infarct via 1. med with thrombolytic tx 2. PCI (angioplasty/stenting
107
absolute contraindication of thrombolytic Tx
hx of cerebrovascular hemorrhage, hx of stroke in past yr, poorly controlled HTN, suspected aortic dissection, active internal bleeding
108
no thrombolytics for
UA/NSTEMI
109
Dressler's syndrome
pericarditis= chest pain due to pericardial inflammation following MI, CABG, or trauma to heart
POST MI complications
110
leading cause of inpatient death after MI
pump failure
111
post MI med management
b blockers, aspirin, ARB or ACE-I if LV dysfunction
